MDJ

Lower Arch Crowding In Relation To Periodontal Disease

Vol.:5 No.:2 2008

AbstractA clinical examination was done to study the relationship between crowding andperiodontal health status in lower anterior region. The occurrence of crowding wasrecorded in fifty adult males with class I angle occlusal relationship who have notbeen received orthodontic treatment before. The sample was divided into two groups:a crowded group of 25 males presented with crowding in the lower anterior teeth, anda normal group of 25 males presented with normal occlusal features and with nocrowding.Scaling (supra and sub gingival debridement) and polishing were done for all thesubjects, plaque and gingival indices were scored before treatment, and then re-scoredat one, two, three and four weeks after treatment.It was found that the gingival index and plaque index are reduced in their value inthe normal group, while the gingival and plaque indices tend to return to their originalpretreatment values in the group of crowded lower anterior teeth and much faster thanthat of a normal group.

IntroductionCrowding of teeth is one of themost common forms of malocclusion (1) and occurs with a frequency of 4058% (2,3) and it is most often observedin the lower incisor region (4).A review of dental effects ofmalocclusion indicated that therelationship between tooth malpositionand periodontal disease was not clearlyestablished.Numerous variables are consideredto predispose and aggravate gingivaland periodontal disease. Bacterialplaque which is considered as themajor etiological factor in thedevelopment of chronic gingivitis maybe more difficult to be removed frommal positioned teeth (5-7).

Some studies have demonstrated a

relationship between malocclusion andmalposition of teeth and periodontaldisease (1,8-11).Other studies, however, did not findsuch a causal link (12-13). Many factorsmay account for these conflictingresults (14-17).The purpose of the present study isto evaluate the role of lower anteriorteeth crowding in the inflammatoryperiodontal disease.

Materials and Methods

The subjects employed in this studywere divided into two groups, one withcrowding and one without.

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Lower Arch Crowding In Relation To Periodontal Disease

The crowded sample was made up

of 25 adult male subjects with class Iangle's classification. (18) .All of themshowed lower arch anterior crowding.The uncrowded sample consisted of25 adult male subjects with normalocclusion (19) .Table (1) shows the distribution ofcrowding through the entire sample.The study sample consisted of fiftymale subjects. The sample wasrestricted to male subjects to avoid sexdifferences in general and fluctuatinghormone levels in particular).The age of the subjects rangedbetween 20 to 30 years old with noprevious history of orthodontictreatment. For crowded sample,subjects should have angle class Imalocclusion with >4 mm of loweranterior segment crowding and foruncrowded sample, the sample shouldhave normal occlusion.Alginate impressions of upper andlower teeth were taken for all subjects.Model casts from impressions werethen used to score the degree of loweranteriorcrowdingwhichwasdetermined from these casts bymeasuring the combined mesiodistalwidth of the mandibular incisors andsubtracing the space available for thoseteeth (4).The plaque index, and the gingivalindex were scored for the lowerincisors and cuspid teeth (20).This wasfollowed by scaling and polishing. Allsubjects were instructed to keep goodoral hygiene with effectiveness plaquecontrol.The scoring for PI and GI wasrepeated four times after periodontaltreatment as follows: one week, twoweeks, three weeks and four weeksafter treatment.The Mann-Whitney V-test wasused to analyze the data.

Vol.:5 No.:2 2008

Table 2 demonstrates the mean

values of plaque and gingival indicesfor normal group scoring inpretreatment period, one, two, threeand four weeks after treatment .It wasfound that the pretreatment score ofmean plaque 2.01 and for gingivalindex was 2.11, this score tends to bereduced in both indices after treatmentwith an obvious reduction thatappeared one week post treatment withmore prominent reduction seen inmean plaque index 0.58 after oneweek.Then they tend to increase tobecome 1.16 and 1.45 for both plaqueand gingival indices respectively but,still appear with reduced values thanthe original value.Table 3 shows the plaque andgingival indices mean in crowdedgroup with their pre and post treatmentgroups. It has been found that theplaque index and gingival index were2.42 and 2.48 respectively inpretreatment score, and they werereduced clearly after one week posttreatment to become 1.7 and 1.81 forplaque and gingival index respectively,and then these scores tend to increaseafter the second week to become 2.39and 2.45 for PI and GI respectivelyafter the fourth week post treatment.This means that the plaque index tendsto return to its pretreatment value muchfaster in the crowded group than in thenormal group.Table 4 shows that the pretreatmentplaque index of the crowded group issignificantly greater than that of thenormal group at a significance level0.01. The pretreatment gingival indexof the crowded group is alsosignificantly greater than that of thenormal group at a 0.05 level ofsignificance.Table 4 also shows that the plaqueindex as the gingival index at one, twoand three weeks post treatment were

Results

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MDJ

Lower Arch Crowding In Relation To Periodontal Disease

Vol.:5 No.:2 2008

Mangoury (11) and Wennstrom (17)

noted an obvious correlation betweencrowding and periodontal status.On the other hand, our findingscome in contrary with the findings ofGould and Picton (12) and Kats (13).It must be noted that many of thesestudies used a combination of gingivalinflammation, pocket depth, and toothmobility to measure the periodontalstatus, however; there are no consistentcorrelation among these differentpathologic changes, (22) combiningthem into a single measure ofperiodontal disease is of questionablevalidity in seeking the effect of aspecific form of malocclusion onperiodontium.Difficulty in maintaining good oralhygiene can result in a greateraccumulation of dental plaque which isconsidered as primary etiologic factorin inflammatory periodontal disease.Improper proximal contact leads tonarrowing of embrasures and this leadsto gingivitis, periodontitis, andpossibly pathologic tooth migration.

not significantly different between the

normal and the crowded groups.The four week plaque andgingival indices showed a differencebetween the crowded and normalgroups at a significance level 0.05Table 5 presents the significancelevel for the changes in plaque andgingival indices after adjustment ofpretreatment baseline level.The difference between thecrowded and normal groups was highlysignificant at four weeks after theperiodontal treatment.

DiscussionThe results of the present studydemonstrated that crowding in theanterior segment of the lower arch is apredisposing factor for the initiationand progression of the periodontaldisease. The direct cause for thisfinding may be related to the difficultyof keeping a good oral hygiene, due toimproper proximal contacts.The findings come in accordancewith several authors (8,11,14,17,21) whofound a convincing correlationbetween malalignment of the teeth andthe loss of periodontal attachment.Buckley (8) found a significantrelationship between the crowding ofmandibular incisors and periodontaldisease.Henoted that a statisticallysignificant relationship was foundbetween irregular teeth, plaque, andgingivitis, and in 1981, Buckleyreconfirmed his previous studiesemphasizing the significant correlationbetween crowding, plaque, andgingivitis.Waerhag (21) concluded that thecrowding may predispose to prematureloss of attachment on the adjacent teethas well as the downward progression ofsubgingival plaque, which may causeeven more periodontal damage